Cardiology| June 01 2000 Inaccuracy of Pediatric Echocardiograms Performed in Adult Laboratories AAP Grand Rounds (2000) 3 (6): 57–58. https://doi.org/10.1542/gr.3-6-57 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Inaccuracy of Pediatric Echocardiograms Performed in Adult Laboratories. AAP Grand Rounds June 2000; 3 (6): 57–58. https://doi.org/10.1542/gr.3-6-57 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: echocardiography, laboratory Source: Stanger P, Silverman NH, Foster E. Diagnostic accuracy of pediatric echocardiograms performed in adult laboratories. Am J Cardiol. 1999;83:908–914. Managed care has resulted in increasing numbers of children being sent to adult laboratories for echocardiographic evaluation.1 Stanger and colleagues at the University of California, San Francisco, studied the accuracy of echocardiograms performed on children in adult laboratories. The authors examined data from 66 patients less than 18 years of age (median age 19 months, range 1 day to 18 years) who underwent echocardiograms in adult laboratories before evaluation by a pediatric cardiologist. Diagnoses from these adult-lab studies were compared with: 1) diagnoses found at catheterization or surgery, or 2) echo diagnoses verified by blinded review by both an experienced pediatric echocardiographer and an adult echocardiographer experienced with congenital heart disease. Diagnostic errors were classified as major, moderate, or minor based on the likelihood of a missed diagnosis resulting in clinical consequences. There was a major or moderate error in interpreting 53% (35/66) of the echocardiograms and of these 72% were interpretive, 17% technical, and 11% both. The incidence of diagnostic errors was not related to patient age, date of study, complexity of heart disease, or the use of color Doppler. Most of the adult-lab echocardiograms were incomplete, often lacking suprasternal and/or subcostal views. Of the 35 patients with adult-lab major or moderate diagnostic errors, 29 (83%) underwent subsequent pediatric-lab echocardiography with results that altered clinical management. The greater than 50% rate of major or moderate diagnostic errors reported by Stanger and colleagues for adult-lab echocardiograms is unacceptable. Hurwitz and Caldwell, in reviewing 100 pediatric patients studied in an adult echo lab, found that nearly half of the studies were technically inadequate or were interpreted incorrectly.2 As technology has improved, the diagnostic accuracy of pediatric echocardiography has become very high. In fact, most children now undergo cardiac surgery based on echocardiography alone, without cardiac catheterization. This accuracy is dependent not only on technological advances, but also on the experience of both the sonographer and the cardiologist. A cooperative patient and clinical correlation are critically important in the optimal use of this diagnostic test. The findings of Stanger and colleagues are important but not surprising. Most adult cardiologists have had little training in the evaluation and management of congenital heart disease. This is supported by the fact that errors of interpretation (alone or with technical errors) accounted for 83% of the diagnostic errors made in the adult echocardiography labs. Stanger et al comment on potential sources of error in this retrospective study and suggest that pediatric-lab echo results may have been improved by the availability of prior adult-lab echo results and clinical input from a pediatric cardiologist who had clinically evaluated the patient before echocardiogram. In fact, this lends support to having specific clinical information available prior to performing and interpreting echocardiography in children. Physicians caring for pediatric patients should be aware of the differences between adult and pediatric echo labs. In some cases,... You do not currently have access to this content.